In evaluating gait disturbances, a physician will obtain the patient’s medical history, including past medical conditions, medications and other treatments. In the study of a patient’s medical history, a physician evaluating a gait disturbance may go over many factors, such as:

• Duration and possible cause of the gait disturbance
  
  
• Effect the disturbance has on the patient’s daily activities
  
  
• History of illness or trauma that may be linked to the disturbance
  
  
• Symptoms that may be associated with the disturbance, including fever, pain, swelling and redness
  
  
• Location, duration and severity of symptoms
  
  
• Aggravating and relieving factors

A gait evaluation allows a physician to study a gait disturbance and pinpoint possible weaknesses and causes. The patient will typically be asked to walk around while the physician observes a number of factors.  The patient may also be asked to run, hop on one leg, then the other, walk on heels and then toes or walk in tandem (placing one foot directly in front of the other). The physician will look for any abnormalities in gait, such as festination (involuntary tendency for steps to accelerate and become smaller), foot slap or shuffling.

During the physical examination, the physician will investigate many factors that could not be seen in a gait evaluation alone. The physician will look for or observe many factors, including:

• Range of motion of spine, hips and knees
• Muscle strength
• Tenderness in joints or bones
• Inflammation of joints, tendons or muscles
• Discrepancy in leg length
• Evidence of pinched nerves
• Abnormal curvature of the spine, such as scoliosis

To help diagnose possible causes of the gait disturbance, various tests may be ordered. X-rays are almost always performed if the cause of the gait disturbance is not obvious. Even if the cause is obvious, many physicians prefer to examine an x-ray to ensure that there are no complications, such as coexisting conditions. Other tests that may be done include:

• Bone scan. A type of radionuclide imaging that indicates abnormal areas in bones. A bone scan may locate any deformities and evaluate bone density.
  
  
• Ultrasound. Imaging of soft tissues via high-frequency sound waves. This test may identify abnormalities in soft tissue such as tears or inflammation in ligaments or tendons.
  
  
• CAT scan (computed axial tomography). Bone imaging via multiple x-rays from many angles. A CAT scan may identify bone problems (e.g., fracture) that may be hidden behind other structures in a plain film x-ray.

• MRI (magnetic resonance imaging). Body imaging via powerful magnets. MRI may locate problems in soft tissues over a much larger area than ultrasound. It may also be more sensitive than other imaging tests in the detection of problems including tears in muscle, ligaments or tendons.
  
  
• Synovial fluid analysis. Laboratory analysis of the fluid that lubricates the joints. This test may be used to identify inflammation and infection that can cause gait disturbances.
  
  
• Complete blood count (CBC). Laboratory analysis that measures the composition of blood cells in the blood. This blood test may be used to identify elevations in white blood cell levels, which may indicate infections.